The Midwifery Pan-London Practice Assessment Strategy: an evidence-based approach

Transcription

1 The Midwifery Pan-London Practice Assessment Strategy: an evidence-based approach Lindsay Gillman 1, Georgina Sims 2 and Michelle Knight 3 1 Associate Professor, Kingston University & St. George's, University of London 2 Associate Professor, Head of Department of Midwifery, Kingston University & St. George's, University of London 3 Specialist Midwife Scottish Maternity & Midwifery Festival

2 Why worry about grading? NMC (2009) Standards for pre-registration midwifery education, Standard 15 states that: Clinical practice must be graded and be counted as part of the academic award assessment of practice, which is direct hands-on care, must be graded. The grades achieved must contribute to the outcome of the final academic award (p.17-18)

3 Drivers for development The driver for developing a new model came from the requirement to develop a standardised practice assessment document (PAD) for use by the eight universities with midwifery commissions from the London education and training boards (LETBs). Project funded by: Health Education England Health Education North West London Health Education South London Health Education North Central and East London

4 Challenges Eight universities, and therefore eight different: programmes curriculum structures practice assessment documents grade criteria student development models assessment approaches multiple partner NHS Trusts

5 Learner and assessor experience SurveyMonkey was used to elicit feedback from students and midwives about the documents and processes for assessing and grading students in practice (June 2014). Student response: 202/330 completion rate: 61.21% Midwife response: 69/187 completion rate: 36.89% (We also undertook stakeholder events and meetings and made over 1,000 face-to-face contacts).

6 Survey Results Midwives Only 30% felt that the current model enabled them to fully assess the student 33% did not find the assessment criteria easy to interpret 81.4% felt that the current model did not enable the assessment of professional values 58.5% did not consider the academic level criteria to be appropriate 21% were unable to differentiate between the levels of grading

7 Survey Results Students 32.6% felt that the current model did not enable them to be fairly assessed by their mentor 23.7% did not find the assessment criteria easy to interpret 53.5% felt that the current model did not enable the assessment of professional values 56% did not consider the academic level criteria to be appropriate 43.6% felt that their mentors were unable to differentiate between the levels of grading

8 How should we develop a new model? The Holy Grail of being able to fairly assess practice would achieve what may be seen as a very desirable goal for measuring the art of midwifery as well as its science. Students who excel at practice might benefit from this aspect being formally acknowledged (Darra et al. 2003: p.44).

9 Key messages from the literature for developing assessment of clinical competence The use of carefully designed rubrics facilitates objective assessment and may control grade inflation (Donaldson and Gray 2012) Rubrics promote consistency in scoring, encourage selfimprovement and self-assessment, motivate learners to achieve the next level, provide timely feedback, and improve instruction (Boateng et al 2009). Student benefits include increased critical thinking and a more realistic approach to self-evaluation (Isaacson and Stacy 2009). Concept based assessment optimises development towards autonomy (LME UK 2014)

10 Developing the new models for competency based assessment The limited available literature and evidence suggest that the use of rubrics and a conceptual approach to the assessment of clinical performance are beneficial for the learner, and reduce subjectivity in the assessor. The challenge was to create a model to support this approach.

11 Rubrics An assessment tool that uses clearly defined criteria and proficiency levels to gauge student achievement of those criteria (Montgomery 2000 cited by Donaldson and Gray 2011 p.106). Rubrics can be either analytical and holistic. Analytical rubrics allow for the separate component of the task to be evaluated. Holistic rubrics consider all of elements in a combined manner (Truemper 2004 cited by Donaldson and Gray 2011 p.106). Rubrics consist of three key components: - Clearly defined performance criteria/elements (KAS) - Detailed descriptions of what a performance looks like at each level of proficiency - A Rating scale (Excellent to Satisfactory) (Moskal and Leydens 2000, Walsh et al cited by Donaldson and Gray 2011 p.106)

12 Concept based assessment Conceptual Knowledge is the inter-relationships among the basic elements within a larger structure that enable them to function together (Anderson and Krathwohl 2001; Bloom 1956) Conceptual Knowledge is knowledge rich in relationships and understanding It is a connected web of knowledge, a network in which the linking relationships are as prominent as the discrete bits of information. By definition, conceptual knowledge (unlike procedural knowledge) cannot be learned by rote. It must be learned by thoughtful, reflective learning. Conceptual knowledge is also known as: The kind of knowledge that may be transferred between situations. This is different from Routine Knowledge, which is knowledge that is applicable only to certain situations.

13 The challenge and the opportunity To create the unholy union of incompatibles? (the grading and assessment of competence)(holroyd 2003) So we developed holistic rubrics, that are concept based, demonstrates professional development and allows grading to be applied.

14 Assessment of professional values Compassion in Practice Vision and Strategy: An Approach in Midwifery Care (2012)

15

16 Professional values Summative assessment Commitment: The student midwife maintains an appropriate professional attitude regarding punctuality and personal presentation that upholds the standard expected of a midwife, in accordance with the organisation and university policies. Achieved Yes Achieved No Comments Care: The student makes consistent effort to engage in their learning in order to contribute to high quality, evidence based, woman-centred maternity care. Competence: The student midwife is able to recognise and work within the limitations of their own knowledge, skills and professional boundaries The student demonstrates the ability to listen, seek clarification and carry out instructions safely in order to contribute to positive health outcomes for women and the best start in life for babies. Communication: The student midwife demonstrates that they can communicate clearly and consistently with colleagues, women and their families. The student is able to work effectively within the multi-disciplinary team with the intent of building professional caring relationships. Courage: The student midwife demonstrates openness, trustworthiness and integrity, ensuring the woman is the focus of care. Compassion: The student contributes to the provision of holistic, responsive and compassionate midwifery care with an emphasis on respect, dignity and kindness.

17 Professional development models Established development models such as Bondy (1983) and Benner (1984), Bloom s (1956) taxonomy, Dreyfus (1980), Eraut (1994), and Robinson (1974) all illustrate a staged development trajectory Movement is from a dependent state with limited knowledge and ability for application, to an independent self-determining or autonomous state. A concept based approach needs to combine academic grade descriptors within a development framework, to facilitate student assessment at the appropriate stage and level.

18

19

20

21 References Anderson, L.W. (Ed.), Krathwohl, D.R. (Ed.), Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., Raths, J., & Wittrock, M.C. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's Taxonomy of Educational Objectives (Complete edition). New York: Longman. Boateng, B. A., Bass, L. D., Blaszak, R. T., Farrar, H. C. (2009) The Development of a Competency-based Assessment Rubric to Measure Resident Milestones. Journal of Graduate Medical Education 1(1): pp doi: / Darra. S, Hunter. B, McIvor, M, Webber, F, Morse, N. (2003) Developing a midwifery skills framework. British Journal of Midwifery, 11 (1) pp Donaldson, J. Gray, M. (2012) Systematic review of grading practice: Is there evidence of grade inflation? Nurse Education in Practice 12 (2012) p [doi: /j.nepr ] Holroyd, C. (2003) Changing assessment in higher education: policy, practice and professionalism, EdD thesis, University of Sterling Lead Midwives for Education UK (2014) Grading Practice in Midwifery Education: developing autonomous midwives for the future Conference presentation ICM 2014 NHS England (2012) Vision and Strategy: An Approach in Midwifery Care [last accessed ] NMC (2009) Standards for pre-registration midwifery education. London: NMC Seldomridge, L.A., Walsh, C.M. (2006)Evaluating student performance in undergraduate preceptorships. Journal of Nursing Education, 45 (5), pp Williams, M. Bateman, A. (2003) Graded Assessment in Vocational Education and Training, Australian National Training Authority, Leabrook, Australia pp. 1 66